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The gift of life

IN BRITAIN alone around 1,000 people die every year for lack of an organ transplant, and another 10,000 are waiting for one. For many, this is because Britain has an “opt-in” regime of informed consent: 90% of Britons say they approve of organ donation, but only 30% have signed up. Most other European Union countries have some form of presumed consent, in which everyone is assumed to be a donor unless he expressly “opts out”. This week the British Medical Association, which represents doctors, urged switching systems. But this in itself may not be enough. Spain has an opt-out system and leads the league with around 32 deceased donors per million people; but so does Greece, and it lurks near the bottom with four. Americans, like Britons, have an opt-in system, but also one of the highest total donation rates in the world. Indeed, culture and capacity may matter more than legal regimes. Spain succeeds by managing the medical requirements of organ donation superbly and selling it emotionally to the public. In poorer countries, grey markets in organ donation may contribute to higher living transplant rates. For more, see article.

I'm very tolerant of people's attitudes, in general, and I will fight the good libertarian fight for those who wish to do stupid things that hurt themselves, because we should all be free to be stupid. But your ignorant attitude towards organ donations ("It's creepy") could well lead to the loss of other people's lives. Go educate yourself enough about organ transplants that you'll feel good about saving lives rather than 'creepy' because of some urban myth foolishness or an unwillingness to consider what happens when you die. Do it for the lives you could save.

I used to live in the UK and now live in California. Like the article says, both are "opt-in", but the implementation is subtly different: In the UK, would-be donors have to get a "Donor Card" and keep that in their wallet. In the US, you simply check a box when getting or renewing your driver's license, and your choice is reflected on the license itself.

I never had a Donor Card in the UK, although I presume they're fairly easy to find. I've been an "organ donor" for a while in the US. The US system means that people *have* to make a decision at regular intervals, whereas in the UK, people need to go out of their way to become an organ donor.

That America has a higher deceased organ donation rate than the US has little to do with "culture" though, and more to do with legal and structural circumstances: In the US, most people have driver's licenses, partly because in much of the country you need a car to get around, but also because the driving test is ludicrously easy. In the UK, the driving test is (sensibly) much harder, and because of the population density and high cost of driving, fewer people need to drive.

Moreover, in the US, you must carry your driver's license while driving. That means people carry their driver's license (and with it, their choice for being an organ donor) at all times. The UK doesn't require people to have their license with them while they're behind the wheel. So even if the UK did add an organ donor indicator to their driver's licenses, there's no guarantee that it would be available at the scene of an accident when it's needed most.

Here's an idea: Encourage the sale of motorcycles with a tax break, and triple the cost of your motorcycle driver's license if you don't volunteer to be an organ donor. The organ donor system needs more healthy young people with fatal head injuries, and nothing delivers that like motorcycles. Get rid of helmet laws, too, for an extra bonus.

As those who have the misfortune of reading my posts know, I'm a vehement supporter of all things American. To be honest: of the vast majority of them: I'm against the death penalty and know nothing of baseball.

But to see Americans overjoyed by America being number (what? 3) does make me smile at the complex.

Have you seen any Iberian boasting of being even better?

C'me on! Don't treat stats as if they are championships. We are all better at something, worse at others. Let's try to make better the things at which we are bad, and maintain the ones we are good at.

The problem isn't a lack of registered donors; for most adults, healthy mortality rates times organ donar rates provide perhaps 10 times the number of organs required.

There must be greater emphasis on timely organ collection - if a pedestrian or motorist is declared dead at the scene, the kadevar should immediately be dispatched for priority harvesting/ distribution.

Are people in the States paid for organ donations (from living people)? That's maybe why in Spain the donation rate is so high for deceased and so low for living people: they don't get paid for donations. Donations are considered a pure altruistic action for the general wellbeing of society (same for blood donations... the more you get it's a snack to recover energies afterwards). Commodification of bodily parts for trade is socially seen as wrong (as in "someone affluent enough takes advantage of his position of relative power to exploit someone under financial distress"). Although blood donation rates are really high in Spain among the living people, they rather wait to be death before donating their organs. Interesting contrast... I'm sure someone already wrote a paper on this.

Are people in the States paid for organ donations (from living people)? That's maybe why in Spain the donation rate is so high for deceased and so low for living people: they don't get paid for donations. Donations are considered a pure altruistic action for the general wellbeing of society (same for blood donations... the more you get it's a snack to recover energies afterwards). Commodification of bodily parts for trade is socially seen as wrong (as in "someone affluent enough takes advantage of his position of relative power to exploit someone under financial distress"). Although blood donation rates are really high in Spain among the living people, they rather wait to be death before donating their organs. Interesting contrast... I'm sure someone already wrote a paper on this.

It's nice to see the US leading in something positive. It's also nice to see that an "opt-out" donation system isn't necessary, or perhaps even desirable, in order to have a high donation rate. In the US, a gradual approach, based almost entirely on education, has achieved more than coercion ever could.

Education has been directed everywhere that it's needed, as well. The public has been taught that organ transplants save lives and that the creepy urban legends about kidney thieves aren't true, and nobody is going to steal their organs or "pull the plug" on them just to get them. This is important for a voluntary donation program and it worked. Along with that, doctors have been taught how to talk to potential donor families at a vulnerable and emotional time. Most doctors naturally would rather not broach the subject, but in the long run it's better if they do. Even celebrity organ recipients are a factor in changing the minds of people who are into the popular culture that way. Lastly, lawmakers had to be persuaded to allow driver's licenses to be used as an "opt-in" donation mechanism.

I have two friends who are alive today only because they were able to receive organ transplants, so I've seen first hand how it works and how successful it is. The medical technology in terms of both the surgery and the drugs is really good these days. There's room for one last big step on the medical end, getting the recipient body to fully recognize the donor organ as its own, and of course there's always the looming practical matter of how to pay for a medical procedure that typical runs around half a million dollars.

Beyond that, though the real limitation on transplants is donations. The problem is only going to get worse as more and more patients, who in the past would have had to simply die, now become eligible for organ transplants. Meanwhile, the main sources of health young organs -- victims of motor vehicle accidents and shooting -- are diminishing as cars get safer and crime rates go down. One hopes that human organ transplants will only be needed as a temporary measure until synthetic lab-grown organs are available. That might be a very long wait, though.

OPT-IN: Donors must sign up and consent to be an organ donor, usually prior to any catastrophe. This system is in use in America.

OPT-OUT: A donor is presumed to be an automatic organ donor unless evidence or testatment can be found to deny consent to organ donation. This is in effect in most Western European Countries. And it speeds the process and access of organ harvest.

There are benefits and disadvantages to both. I think Harley Davidson Motorcycle Riders should be treated as an Opt-Out. We need their organs.

Fightaging, a U.S. website reports that Tissue printing startup Organovo, of the Methuselah Foundation...advanced bioprinting platform can replicate essential biology for research, drug discovery and development and, eventually, for therapeutic applications," stated Keith Murphy, chief executive officer of Organovo. "We have found success in achieving early revenue through strategic collaborations, and this funding will allow us to extend the reach and uses of 3D bioprinting through growth and innovation in the coming years."

Given that at this stage in their life cycle they are essentially a research equipment manufacturer, that sort of money - while small in terms of medical development in the mainstream - should be enough to get them to the next level. You might recall an h+ Magazine article from a couple of years ago that gives a good overview of what the company aims to achieve:

Quote:Dr. Forgacs ultimately foresees fully implantable organs printed from a patient's own cells. "You give us your cells: we grow them, we print them, the structure forms and we are ready to go," he says. "I am pretty sure that full organs will be on the market [one day]." A printed biological heart might not appear exactly like an embryonic heart with a pericardium, two superior atria, and two inferior ventricles. But it will perform the same function: pumping blood throughout the blood vessels.
The second item relates to the preservation of organs for later transplant: this is a big logistical hurdle. A great deal of the processes of present day transplantation and early tissue engineering are completely shaped by our inability to reliably store large, complex tissues for the long term, without damage. The process of decellularization may be a practical way to work around the issue, though it remains to be seen if the economics work out yet: donated organs can be decellularlized, the scaffold stored at low temperature, and then warmed up and repopulated with a patient's cells in a matter of days. Here is a note from ScienceDaily, which leads to an open access research paper that is available in PDF format:

Quote:[Researchers] studied various strategies for freeze-drying porcine heart valves. After the cellular material was removed, they freeze-dried the heart valve scaffolds with or without sucrose and hydroxyl ethylene starch, and then compared the stability and elasticity of the freeze-dried scaffolds to assess the effectiveness of these lyoprotectants in preventing degradation of the scaffold. ... Tissue freeze-dried with sucrose alone displayed less porosity compared to tissue freeze-dried with the sucrose/HES mixture, whereas no significant differences in biomechanical properties were observed. Decellularization decreased the elastic modulus of artery tissue. The elastic modulus of freeze-dried tissue without protectants resembled that of decellularized tissue. The elastic modulus values of freeze-dried tissue stabilized by lyoprotectants were greater compared to those of decellularized tissue, but similar to those of native tissue.
Lastly for today, an article on one of the challenges of tissue engineering that people outside the field don't tend to think all that much about, which is that it is exceedingly difficult to convince tissues to form exactly the desired shape, with exactly the right mechanical properties, and with the right cells in the right place in that shape. A lot of researchers are spending a lot of time on determining how to cultivate tissue of the right size and shape; the strategies needed vary greatly by tissue type and other circumstances. In any case, here is an article on tubes:

Quote:In another advance for the field, researchers have now demonstrated a strategy to fabricate tubular structures with multiple types of cells as different layers of the tube walls. This method may be widely used in simulation of many tubular tissues and enriches the toolbox for 3D micro/nanofabrication by initially patterning in 2D and transforming it into 3D. ... To demonstrate the capability of their method, the scientists successfully simulated the structure of a human vessel-like structure - the tubular wall has three layers, and in each layer there is one representative type of cells: endothelial cells, smooth muscle cells and fibroblast cells (from inside out). This kind of tubular structure with multiple types of cells can be applied in tissue engineering such as arterial and venous grafts in vivo. And [the] preparation method of stress-induced rolling membrane can be applied to fabricate other self-assembled 3D structures.
You might compare the methodologies in the technology demonstration quoted above with the approach used in growing mouse teeth to get a sense of just how broad the range of necessary techniques is.